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Surgical treatment of purulent pericarditis in children
Insights
Purulent pericarditis in children is often caused by Hemophilus influenzae. Immediate pericardiocentesis is recommended for diagnosis, with early pericardiectomy advised for H. influenzae or persistent symptoms.
Area of Science:
- Pediatric Infectious Diseases
- Cardiology
- Surgical Procedures
Background:
- Purulent pericarditis is a serious condition in children.
- Early diagnosis and effective treatment are crucial for favorable outcomes.
Purpose of the Study:
- To review the clinical characteristics and treatment outcomes of pediatric purulent pericarditis.
- To evaluate the efficacy of pericardiocentesis and pericardiectomy in managing this condition.
Main Methods:
- Retrospective analysis of 15 children diagnosed with purulent pericarditis between 1971 and the present.
- Review of causative organisms, treatment modalities (antibiotics, pericardiocentesis, pericardiectomy), and patient outcomes.
Main Results:
- Hemophilus influenzae was the most common pathogen (7 cases).
- Pericardiocentesis alone failed in 9 of 13 patients, particularly those with H. influenzae.
- Pericardiectomy led to successful recovery in all 7 patients who underwent the procedure.
Conclusions:
- Immediate pericardiocentesis is vital for diagnosis and initial management.
- Early pericardiectomy is recommended for H. influenzae infections, recurrent tamponade, or persistent sepsis unresponsive to antibiotics.
Abstract:
Since 1971 we have seen 15 children with the diagnosis of purulent pericarditis. The causative organism was Hemophilus influenzae in seven, Staphylococcus aureus in three, and five were due to other organisms. In one child the diagnosis was unsuspected until autopsy. The other 14 patients were all treated with intravenous antibiotics to which the organism was sensitive. One child had an immediate pericardiectomy because of tamponade. The other 13 patients had pericardiocentesis for diagnosis and initial therapy. Pericardiocentesis alone resulted in recovery of four patients and failed in nine, including all seven patients with H. influenzae. These nine had recurrent tamponade or a persistent picture of sepsis that was unresponsive to repeated pericardiocenteses and necessitated operative intervention. The procedure used was subxiphoid tube drainage in two patients. One recovered and the other required further operation. The remaining seven patients were treated with pericardiectomy. All pericardiectomy patients recovered without complications or recurrent symptoms. Survivors are asymptomatic with no evidence of pericardial constriction. We recommend immediate pericardiocentesis for diagnosis and initial therapy. Early pericardiectomy should be performed if the causative organism is H. influenzae, if tamponade occurs after initial pericardiocentesis, or if fever persists despite appropriate antibiotics.